Global bioethics blog

Promoting reflection on bioethics and research ethics issues in Sub-Saharan Africa

Saturday, November 28, 2009

The rich using the poor as beauty products? (with update)

This one falls into the 'obviously wrong if true category.' According to reports last week, police in Peru have arrested members of a gang who murdered a string of peasant farmers, drained the fat from their dead bodies, and then attempted to sell it to European cosmetics manufacturers. How the fat was extracted from the corpses is gruesome enough to gain the attention of bad horror film producers, and I will spare you the details. What is interesting, though sick, is the very idea of an international black market in human body fat for cosmetic purposes. The rich have long had (or have been sold) some strange notions about special concoctions allegedly capable of turning back the hands of time, or at least the signs of wear and tear on the human face. But using body fat is a new one, and harvesting it among Peru's poor (rather than more corpulent and frequently liposuctioned populations elsewhere) just seems gratuitous -- not that there is some part of the world where this should pass as acceptable behavior.

As the Independent points out, the gangsters oddly discarded more lucrative items in the form of livers, kidneys or lungs. My instinctive response: don't give them any ideas.

UPDATE (Dec 1, 2009): it seems to be false, after all. Since the story broke, no evidence has been uncovered to support the gruesome tale of murder and body fat sales, and the anti-kidnapping investigator at the origin of the story has been suspended. The story seems to have been a recycled version of the old Peruvian myth about Pichtacos -- a kind of South American vampire/cannibal. Rumor has it that the police authorities told the story just to distract the Peruvian public from real social problems. But who knows if we will ever get to the bottom of this one.

Thursday, November 19, 2009

National Health Insurance in South Africa put on hold

South African president Jacob Zuma and American president Barack Obama do not seem to have much in common. Obama went to college, and not just any college: Yale University. Whereas Zuma only attended school until Standard 3 (or Grade 5). Zuma has been tried in court on charges of rape and corruption, and during questioning stated that risk of HIV transmission could be minimized by taking a shower after sex. Whereas Obama used to smoke. Zuma has 4 wives, Obama has Michelle. Despite these and other differences, the two presidents have one thing in common: they are both currently involved in controversial national health care reforms. In the case of Zuma, it is the proposed National Health Insurance (NHI), which has been planned since the African National Congress first took office in 1994.

Social, political and economic inequality, as many studies have indicated, are bad for your health. It would seem to follow that decades of Apartheid would be generally bad for the health of those at the lower end of the ladder in South Africa. And it is. I spent the early part of this week marking medical ethics exams from budding doctors at Groote Schuur Hospital in Cape Town, and some of the case studies they presented were positively hair-raising. So it makes ethical sense, in principle, to increase access to health care for South African citizens.

While everyone seems to agree on the basic principle, the details of the NHI are vexing, and the discussions bring out the old social tensions and wounds. One large question is where the massive amount of money in support of the scheme is to be drawn from. If it is through taxation, this causes concern among those better off in South Africa, who are already been taxed to support the existing public health care system -- though many of them go to private health services when they are sick themselves. There is also a worry that private health institutions would be 'de-skilled' and overwhelmed if subjected to government demands to focus on primary care services. Requiring well-off South Africans to use public health care might also, it is feared, lead to people leaving the country: both patients who fear a drop in their standard of care as well as doctors who do not want to work in sub-standard conditions for less pay. There seems to be a general feeling that if the NHI might lead to the generalization of the health care standards currently provided in the public sector. It depends who you ask, and where you ask, but generally speaking opinions about the health care on offer in public hospitals and clinics are not positive. This is an understatement. The problems the government has had in doing just one thing -- providing antiretroviral therapy for those who need it -- draws serious doubt on its ability to provide a broad spectrum of services at an adequate and affordable standard. For the poorest of the poor, on the other hand, the promise of some (perhaps not great) services may look better than none.

Olive Shisana, head of the Human Sciences Research Council (which is responsible for drafting versions of the NHI) likes to say that opposition to the NHI is based on myths. But this week the Health Minister put the NHI on hold, perhaps for as long as five years. Reason? The public health sector is said to be in shocking shape, so shocking that bringing in the NHI wouldn't help matters. So back to the drawing board.

Sunday, November 08, 2009

Delivering vaccines in Africa: some unethical obstacles

The attention and money thrown at the H1N1 virus seems to grow by the day, even if the numbers of H1N1 related deaths, relative to other causes of mortality (including plain old seasonal flu), are still very modest. People actually die from H1N1, so it is not nice to make light of it, and because it is contagious, the death toll will rise, though we don't know how high or for how long. Nevertheless, there is no way of getting around the impression that the world's media is drawn to the latest viral threat to the richer developed nations, where the knight in shining armour is played by multinational pharmaceutical companies, whose cutting-edge research thankfully produces the latest vaccine, while the media makes rapid and widespread vaccination seem like the only rational response, and governments and local health agencies stand to be criticized for not getting vaccines into bodies fast enough. The significance of the H1N1 virus as a threat to humanity? Only time will tell. But that a great deal of money is being made: that is already certain.

Elsewhere in the world, other fish are frying. Forget new cutting-edge research for new diseases: in many countries, it is hard enough just to get the old vaccines administered, for the boring old diseases, the ones that people in developed nations hardly get anymore because they are routinely vaccinated against them. Take measles. Two troubling stories about measles vaccination in Africa came in this week.

First, here in South Africa, some media sources managed to revive the discredited measles-autism link, i.e. that the measles vaccine causes autism in children. A little media ethics for journalists working on public health issues could go a long way, and hopefully these incidents will not cause setbacks for measles eradication in South Africa, similar to the problems with polio vaccination in Nigeria some years back. The recent decline in measles mortality in Africa is a success story, but only conserted and sustained efforts (including communication of accurate health information) will keep those numbers going down.

Second, in the Democratic Republic of Congo, measles vaccination efforts face an unusual adversary: government troops. Medecins Sans Frontieres (Doctors without Borders) has accused the Congolese government of using their vaccination sites as bait. Due to a measles epidemic, MSF was vaccinating thousands of children in sites locations that are controlled by the Forces Democratique de Liberation du Rwanda (FDLR) . Knowing that people in the area would gravitate to the opportunity for measles vaccination, Congolese government troops apparently attacked all seven sites with deadly force, scattering populations (including children) into the bush. It remains to be seen if people in the area will trust going back to MSF sites for medical care, and in this troubled part of the world, that is about the only decent medical care around.

Monday, November 02, 2009

Let us compare epidemics

There is always something a bit distasteful about comparing human tragedies, but it is also inevitable. The tsunami in 2004 was terrible, but was it as bad as the ongoing HIV/AIDS epidemic in Africa, which has taken millions of lives over the last decades? Darfur is bad, but has it really reached Rwandan genocidal proportions? We inevitably make these sorts of comparisons in order to get some sort of grip on what people ought to care about, and what nations ought to respond to with their finite resources. And we often lose our way.

The H1N1 virus has captured media attention, as well as substantial funding for task forces, response plans and research, particularly as increasingly more deaths have been linked to it. As has been observed many times, the 'media life' of a virus depends in large part on the extent to which citizens (especially ordinary citizens) of North America and Europe are affected by it, or are likely to be affected by it. When the centers of the world's power is under viral threat, vast resources may be mobilized, even if the numbers in terms of morbidity and mortality are, relatively speaking, small. Worse epidemics, elsewhere, receive much less press and support.

The point was not lost on those aware that today was World Pneumonia Day. Pneumonia is the greater killer of children worldwide. It is responsible for more deaths in children (2 million a year) than HIV/AIDS, measles and malaria combined. The tragedy is that we long ago developed effective vaccines to prevent it, and antibiotics to treat it, but it generally affects children away from the centers of the world's power, particularly in sub-Saharan Africa and South-East Asia. While many lives could be saved in delivering known effective medicines to these populations, there is not much money to be made in the endeavor, so rallying support for pneumonia initiatives tends to be an uphill battle. But it is a matter of fighting the good fight, a matter of trying to regain some sense of proportion, and a matter of not being entirely distracted by the latest virus on the 24-hour news cycle.